Can practice make perfect?
When we write a list of important relationships in our lives we rarely add ‘GP’ to the list of loved ones. Mark Brown explores ways you can make your doctor work for you
So what do GPs do?
General Practitioners (GPs) play an important role in managing our health care. They’re basically our ‘go to’ people for everything about our health that isn’t life-threatening and urgent. They’re the people who are there to make sure that we keep as well as possible over the span of our lives. The idea of general practice is based on long-term relationships between GPs and their patients.
Says Dr Jonathon Tomlinson, an NHS GP in London: “My job is to find out what’s going on in my patient’s life, to take a medical and psychiatric history, and explore their ideas, concerns and expectations: Do they think they’re depressed; have they thought about what to do about it, if so, how much? What ideas, concerns, expectations do they have about treatment?” It’s also his job as a GP to work out what the best course of action is to help a patient to be as well as possible.
People have been known to complain that GPs lack specialist mental health knowledge and therefore don’t have the skills to deal with patients with mental health difficulties correctly. While this is may be true in some cases, there are steps you can take to make sure that in the relationship between you and your GP that it’s not you, it’s them.
What can you do to help them help you?
When we’re growing up we’re often taught to regard doctors as authority figures. The residue of this often manifests in the strange compulsion we have to not be completely honest about our lifestyle or health when a GP asks us. It’s one of the things that make it hard for a GP to make good decisions about the best treatment to help you. Shame or stigma about mental health can often compound this; meaning that when we go to the doctor we play down our difficulties even though it’s those difficulties that brought us to them in the first place.
Says Dr Tomlinson: “Try to answer all the doctor’s questions honestly, including questions about alcohol & drugs. Many times I’ve been told by patients that they’ve tried ‘everything’ but cannot remember any of the names, or when or for how long. Try to bring a list of medications & therapies you have used before, for how long, and what good or bad effects they had.”
Remember, while it’s important your GP knows about things that are troubling you and anxieties, worries and challenges that you have, they won’t be able to directly alter things like living in a bad situation or experiencing money difficulties. Try to make a list of the things that you want to tell the doctor if you know your mind goes blank when you’re put on the spot.
When people see a GP about their mental health they sometimes complain of feeling ‘fobbed off’ because they haven’t been helped in the way that they expected. While visiting the GP about a health concern might be the end of months of worry for us, for the GP it’s just the start of the process of working out what will help us. Very often we only go to see our GP because we feel something is serious. This decision is one into which we invest a lot of emotion. Some people feel that being prescribed medication is being fobbed off, while others feel they are being fobbed off if they aren’t prescribed it.
“Some patients come with a clear idea about what works for them, especially if they are having a recurrence of a relapsing condition, and it may well be best to restart treatment immediately,” say Dr Tomlinson. “I rarely prescribe medication or refer for therapy on a first appointment for the simple reason that most patients want to think about the options. Most patients I meet with a first episode of depression and or anxiety do very well, and many get better without drugs or therapy. Lots of patients and doctors worry that medications are overused, and side effects like impotence, nausea or weight-gain are under-reported and benefits over-stated. Likewise, many patients report that therapy isn’t helpful or can even make things worse. I see my role to listen to my patients, hear their story, support them as best I can, and refer to therapy or use medication when we both think it’s most likely to be helpful.”
When a GP refers you on to another service it can bring about a mixture of emotions. Sometimes it’s relief that you are going to see a specialist; other times it’s worry about what you’ll do in the meantime.
If you are referred elsewhere or you GP takes a ‘wait and see’ approach this doesn’t mean that there is nothing you can do to help yourself. I’s worth exploring local community organisations for additional support. If you’re experiencing challenges or problems across multiple areas in your life you can begin the process of trying to do something about those, too. With mental health it’s sometimes the mess that we’re in that causes our mental health to worsen and sometimes our worsening mental health that causes a mess. Either way, beginning the process of sorting some of the stuff that’s causing you strife in your life should help to relieve some of the pressure. Your GP might be able to offer you guidance on where to seek local help and support.
If it’s not working out
Sometimes relationships don’t work out. Sometimes, despite everything, we might feel that our GP isn’t taking our concerns seriously enough. Dr Tomlinson suggests that there are a number of things that we can do if that’s the case. The first one is to actually communicate to your GP how you feel: “Say ‘I don’t think you’re taking me seriously’ and then explain why,” says Dr Tomlinson. “Try to remember that prescribing drugs or making a referral isn’t the same as taking you seriously.”
If you feel that the doctor has not given you enough chance to talk through your concerns book a double appointment next time so that you have more time to explain. Also remember that you can always take a friend or family member with you when you see your GP. If you feel that the doctor is missing something important find out more about what you think is wrong with you and what can be done before you go and see them again.
Dr Tomlinson also suggests writing to your GP about your condition if you find it difficult to raise your concerns in person: “Some patients find it very difficult to confront a GP in a consultation,” he says. “I have a few that prefer to put their thoughts & feelings in a letter or email.”
If, after all of that, you still don’t feel that your GP is taking your mental health seriously you have a number of options. Ask to see another GP in the practice if there is more than one GP. In some parts of England you are able to refer yourself for short period of support via the Improving Access to Psychological Therapies service. If this is available your GP practice will have leaflets and details or check online at http://www.iapt.nhs.uk/services/services/. You might also choose to refer yourself to a private therapist. Many operate sliding payment scales, so this might not be as expensive as it first seems. As an absolute last resort you could also go to Accident and Emergency to see the duty psychiatrist, but this should be reserved for situations where you are in acute need and feel that you may be a danger to yourself or others.
If all goes according to plan, you and your GP should end upon the same side, both working shoulder to shoulder to make sure that you have the best health possible. Like most relationships, you’ll know when it feels right.